Papers by Leandro Zacharias
Retinal Cases & Brief Reports, 2022
Supplemental Digital Content is Available in the Text. Acute macular neuroretinopathy is a condit... more Supplemental Digital Content is Available in the Text. Acute macular neuroretinopathy is a condition characterized by an acute paracentral scotoma and subsequent vision loss. Acute macular neuroretinopathy may be triggered by many disorders including viral infections, such as influenza. However, this is to our knowledge the first report of AMN associated with COVID-19 infection. Purpose: To describe a case of sudden visual loss from acute macular neuroretinopathy (AMN) as the presenting manifestation of active COVID-19 infection. Case report: During the quarantine period of the COVID-19 pandemic, a 70-year-old man presented with a 1-day history of a paracentral scotoma of the left eye associated with diaphoresis. Four days later, the patient developed fever (38°C) followed by cough. Oral and nasal swab PCR testing was positive for COVID-19. Visual acuity in the day of presentation was 20/20 in the right eye and 20/100 in the left eye. Multimodal retinal imaging was unremarkable in the right eye, but cross-sectional optical coherence tomography displayed focal hyperreflectivity at the level of the outer nuclear layer associated with disruption of the ellipsoid zone. The corresponding en face optical coherence tomography revealed an inferonasal hyperreflective parafoveal lesion. At 1 month of follow-up, tracked optical coherence tomography of the macula showed resolution of the hyperreflective signal, thinning of the outer nuclear layer, and near-complete recovery of ellipsoid zone integrity. Conclusion: Patients with COVID-19 may rarely present with signs and symptoms of ocular disease. This case report describes a case of sudden visual loss caused by acute macular neuroretinopathy as the presenting manifestation of active COVID-19 infection.
Journal of Biomedical Optics, 2008
A functional Fourier domain optical coherence tomography instrument offering spectral Doppler ima... more A functional Fourier domain optical coherence tomography instrument offering spectral Doppler imaging of in vivo pulsatile human retinal blood flow was constructed. An improved phase-resolved algorithm was developed to correct bulk motion artifacts. Spectral Doppler imaging provides complementary temporal flow information to the spatially distributed flow information of the color Doppler image by providing direct visualization of the Doppler spectrum of the flow whose pattern can be further quantified with various velocity envelope curves and their corresponding flow indices. The coefficient of repeatability on resistance index measurement was assessed by analyzing 14 measurements on two vessels within two normal subjects.
Investigative Ophthalmology & Visual Science, Apr 28, 2009
Revista Brasileira De Oftalmologia, 2004
página 1 de 1, 1 / 1, LILACS, seleciona. para imprimir. Fotocópia. experimental, Documentos relac... more página 1 de 1, 1 / 1, LILACS, seleciona. para imprimir. Fotocópia. experimental, Documentos relacionados. Id: 398687. Autor: Vaidergorn, Paulo Gelman; Susanna Jr, Remo; Oliveira, Cleriston Lucena de; Sakata, Lisandro; Zacharias, Leandro Cabral; Barreto Jr, Jackson. ...
Retina-the Journal of Retinal and Vitreous Diseases, Jul 28, 2023
Purpose: To evaluate the parafoveal macular microvasculature and the macular function in patients... more Purpose: To evaluate the parafoveal macular microvasculature and the macular function in patients with retinal vasculitis associated with Behçet's uveitis (BU). Methods: In 14 patients with inactive BU and 26 control individuals (13 with nonocular Behçet's syndrome and 13 healthy subjects), we analyzed the retinal nerve fiber layer, ganglion cell layer (GCL), full retinal thickness (FRT), foveal avascular zone area and sectorial parafoveal vessel density in the superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus (DCP) using Spectralis optical coherence tomography (OCT) 2 and OCT angiography (OCTA). Macular sensitivity was analyzed using an MP-3 microperimeter. Results: Eighteen eyes (78%) had a best-corrected visual acuity (BCVA) > 20/25. Significant differences were found in BU in comparison to the controls on the OCT and OCTA: 14.8%, 22.4%, and 14.9% GCL thinning in the global, nasal, and inferior sectors, respectively; 6%, 13.2%, and 7.5% FRT thinning in the superior, nasal, and inferior sectors; and 16.8%, 14.9%, 23.6%, 15.8%, and 12.6% mean DCP density reduction in the global, superior, nasal, inferior, and temporal sectors. Microperimetry data demonstrated significant mean reductions of 21% and 23.6% in central and average macular sensitivities, and 28.8%, 40.4%, 27.7%, and 24.2% in the superior, nasal, inferior, and temporal sectors, respectively. Outer plexiform layer elevations were observed in BU (69.6%). Conclusions: BU presented structural and functional macular damage despite good BCVA, mainly affecting the nasal sector and the DCP. On OCT and OCTA, quantitative and qualitative changes can be valuable biomarkers of ocular involvement in BS.
Arquivos Brasileiros De Oftalmologia, 2023
Microperimetry has been used for several years as a form of visual function testing in patients w... more Microperimetry has been used for several years as a form of visual function testing in patients with retinal diseases. Normal microperimetry values obtained with microperimeter MP-3 have not yet been fully published, and baseline values for topographic macular sensitivity and correlations with age and sex are needed to establish degrees of impairment. This study aimed to determine values for light sensitivity thresholds and fixation stability using the MP-3 in healthy individuals. Methods: Thirty-seven healthy volunteers (age, 28-68 years), underwent full-threshold microperimetry using a 4-2 (fast) staircase strategy with the standard Goldmann III stimulus size and 68 test points positioned identically to those in the Humphrey Field Analyzer 10-2 test grid. The fixation stability was simultaneously recorded during the microperimetry test. The relationship between global sensitivity and age was calculated using linear regression analysis. Results: Microperimetry was performed on 37 participants (74 eyes). The global mean sensitivity was 29.01 ± 1.44 (range, 26-31) dB. The mean central sensitivity at 2° measured by the MP-3 was 28.5 ± 1.77 dB in the right eye (OD) and 28.75 ± 1.98 dB in the left eye (OS). The total median fixation stability values within 2° and 4° were 80% and 96%, respectively. The linear regression analysis also revealed an age-related global sensitivity decline per year of-0.051 dB ± 0.018 (OD) and-0.078 dB ± 0.021 (OS). Conclusions: Microperimetry performed with the MP-3 allows for an automatic, accurate, and topography-specific examination of retinal sensitivity thresholds. The results of this study provide a normal and age-matched database of MP-3 microperimetry.
Investigative Ophthalmology & Visual Science, Jul 13, 2018
Arquivos Brasileiros De Oftalmologia, 2020
This content is licensed under a Creative Commons Attributions 4.0 International License. Inverte... more This content is licensed under a Creative Commons Attributions 4.0 International License. Inverted internal limiting membrane flap for the management of optic disc pit maculopathy Técnica do flap invertido da membrana limitante interna para o manejo da maculopatia causada pela fosseta do disco óptico.
Investigative Ophthalmology & Visual Science, Jul 13, 2018
Arquivos Brasileiros De Oftalmologia, Sep 1, 2002
PubMed, Jul 1, 2014
Purpose: To determine if potentially viable alternatives to the clinical use of intravitreal tria... more Purpose: To determine if potentially viable alternatives to the clinical use of intravitreal triamcinolone acetonide should be considered based on a comparative assessment of the in vitro effects of five commercially available corticosteroids. We hypothesized that dexamethasone, betamethasone, methylprednisolone, loteprednol etabonate, and fluocinolone acetonide, at clinically relevant doses, may show different levels of in vitro cytotoxicity to retinal cells. Methods: Cultures of human retinal pigment epithelial cells (ARPE-19) and rat embryonal neurosensory precursor retinal cells (R28) were treated with dexamethasone, betamethasone, methylprednisolone, loteprednol, or fluocinolone acetonide. Cell viability as a measure of cell death was determined by trypan blue dye exclusion assay. The mechanical effect of drug crystals was evaluated by solubilizing the steroid formulations. Mitochondrial dehydrogenase and membrane potential were assessed to measure cell damage. Results: Betamethasone, loteprednol, and methylprednisolone, in commercially available forms, caused significant cytotoxic changes to retinal cells in vitro at clinically relevant doses. This effect was less pronounced with solubilized betamethasone. Dexamethasone at concentrations up to 5 times the clinical dose of free drug injections and 1000 times greater than a drug implant did not cause decreased cell viability. Fluocinolone acetonide at doses 1000 times higher than observed with drug delivery systems showed no cytotoxic effect. Conclusions: Betamethasone, loteprednol, and methylprednisolone exhibited cytotoxicity at clinically relevant doses and do not appear to be good therapeutic options for intravitreal use. In comparison, dexamethasone and fluocinolone acetonide, which exhibited fewer cytotoxic effects than other steroids, may be potentially viable alternatives to triamcinolone acetonide for clinical use.
PubMed, Jul 24, 2023
All-trans retinoic acid (ATRA) is a vitamin A derivative which can increase intracranial pressure... more All-trans retinoic acid (ATRA) is a vitamin A derivative which can increase intracranial pressure, causing visual loss and papilledema. Those patients should be treated similarly to others patients with idiopathic intracranial hypertension. We described a case of a 32-year-old woman presenting with severe visual loss and intracranial hypertension induced by ATRA for acute promyelocytic leukemia, which was treated clinically and with optic nerve sheath fenestration. Patients receiving ATRA therapy should be monitored to neurological and ophthalmic signs and symptoms of intracranial hypertension.
Revista Brasileira De Oftalmologia, 2023
This is a case series about retinal arterial macroaneurysms in three patients recovered from COVI... more This is a case series about retinal arterial macroaneurysms in three patients recovered from COVID-19. None of them had previous past ocular and systemic history. The first patient was a 47-year-old man, with best-corrected visual acuity of 20/20 in both eyes. He presented a cotton wool spot in the right eye and two peripheral exudative retinal arterial macroaneurysms in the left eye. Laser photocoagulation was performed and best-corrected visual acuity remained stable. The second one was a 62-year-oldwoman with acute visual loss in the right eye (best-corrected visual acuity of 20/400). There was vitreous hemorrhage and a peripheral retinal arterial macroaneurysm in the right eye. Laser photocoagulation was performed and best-corrected visual acuity improved to 20/20. The third patient was a 54-yearold woman, with best-corrected visual acuity of 20/20 in the right eye and 20/600 in the left eye. Fundus examination showed multiple layer hemorrhage in the macular region and retinal arterial macroaneurysms in the superior temporal branch. The cases underwent fluorescein angiography, which confirmed the diagnosis of retinal arterial macroaneurysms.
Investigative Ophthalmology & Visual Science, Jul 13, 2018
Protocolo de Pesquisa nº 126/10 intitulado: "EFEITO DA APLICAÇÃO DE ACETATO DE TRIANCINOLONA SEM ... more Protocolo de Pesquisa nº 126/10 intitulado: "EFEITO DA APLICAÇÃO DE ACETATO DE TRIANCINOLONA SEM PRESERVATIVO (TRIESENCE®) EM CÉLULAS DA RETINA: ESTUDO MORFOLÓGICO, ELETRORETINOGRÁFICO E EM CULTURA DE CÉLULAS RETINIANAS" que utilizará 30 coelhos, apresentado pelo Departamento de Oftalmologia e Otorrinolaringologia. Cabe ao pesquisador elaborar e apresentar ao CEP-FMUSP, o relatório final sobre a pesquisa, (Lei Procedimentos para o Uso Científico de Animais-Lei No 11.794-8 de outubro de 2008).
Arquivos Brasileiros De Oftalmologia, 2021
We have reported here the case of a 54-year-old woman with intracranial hypertension that present... more We have reported here the case of a 54-year-old woman with intracranial hypertension that presented with the unique features of unilateral papilledema and peripapillary polypoidal choroidal vasculopathy. Our investigations lead to the diagnosis of idiopathic intracranial hypertension and an incidental small right frontal meningioma. The patient was accordingly treated with oral acetazolamide, followed by three consecutive monthly intravitreal injections of bevacizumab, which resulted in the inactivation of the polypoidal choroidal vasculopathy, marked reduction of lipid exudation, and complete absorption of the subretinal fluid. This case serves as the first documentation of polypoidal choroidal vasculopathy associated with papilledema. It also demonstrates that choroidal vascular abnormalities may occur even when optic disk edema is unilateral, which is an uncommon manifestation of increased intracranial pressure. Prompt recognition of such findings and its appropriate management are essential for adequate treatment and prevention of irreversible visual loss.
Case reports in ophthalmological medicine, 2014
The Shaken Baby Syndrome (SBS) is characterized by subdural hematomas (SH), retinal hemorrhages (... more The Shaken Baby Syndrome (SBS) is characterized by subdural hematomas (SH), retinal hemorrhages (RH), and multiple fractures of long bones without external evidence of head trauma. Subinternal limiting membrane (ILM) hemorrhage, also known as macular schisis, is a characteristic finding of this entity. There is no guideline on the right time to indicate surgical treatment. This report describes an abused child with massive sub-ILM hemorrhage, which showed spontaneous absorption after less than two months of follow-up. Due to the possible spontaneous resolution, we suggest an initial conservative treatment in cases of sub-ILM hemorrhage related to SBS.
BMC Ophthalmology, Mar 24, 2022
Background: Full-thickness idiopathic macular hole (IMH) usually causes serious visual deformitie... more Background: Full-thickness idiopathic macular hole (IMH) usually causes serious visual deformities and visual acuity loss. Pseudophakic cystic macular edema, also known as Irvine-Gass syndrome, is another entity that causes visual disturbances, and occurs mainly after cataract extraction. We present a case report of a patient that was diagnosed with a full-thickness macular hole that spontaneously closed after the resolution of an Irvine-Gass syndrome, which occurred after an uneventful cataract extraction. Case presentation: A 75 years-old female presented with the complaints of decreased visual acuity and color contrast sensitivity on both eyes (OU) and central visual field deformations on her left eye (LE). She was diagnosed with a full-thickness IMH on her LE, and cataract on OU. After an uneventful cataract extraction via phacoemulsification, she developed an Irvine-Gass syndrome at her LE, which was treated topically. The IMH closed spontaneously after the resolution of the Irvine-Gass syndrome, and the patient is being followed with no further complaints. Conclusion: The exact mechanism for spontaneous closure of full-thickness idiopathic macular holes is still not completely understood. In this case, we hypothesize that the coalesced intraretinal cysts caused by the Irvine-Gass syndrome formed a bridge-like structure connecting the inner walls of the macular hole, thus connecting the remnants of the Muller cells which enabled the full recovery of the normal foveal structure.
Evidence-based Ophthalmology
Background/Purpose: We describe a case of full-thickness macular hole formation in a patient with... more Background/Purpose: We describe a case of full-thickness macular hole formation in a patient with exudative age-related macular degeneration after an intravitreal ranibizumab injection and its surgical management. Methods: This case is a retrospective, interventional case report. Results: A 77-year-old woman with bilateral exudative age-related macular degeneration and pre-existing retinal pigment epithelium tear developed a full-thickness macular hole after intravitreal ranibizumab. The macular hole was repaired successfully with pars plana vitrectomy, internal limiting membrane peel, and 16% C3F8 gas fill. Conclusion: To the best of our knowledge, this is the first reported case of full-thickness macular hole after a retinal pigment epithelium tear repaired successfully with vitrectomy, resulting in improved visual acuity.
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Papers by Leandro Zacharias